HUMAN TRAFFICKING: IDENTIFYING AND TREATING VICTIMS By Nicole E. McAmis, Angela C. Mirabella, Elizabeth M. McCarthy, and Cara A. Cama, Frank H. Netter MD School of Medicine, Quinnipiac University on behalf of SAEM’s Residents and Medical Students
Summary
The U.S. Department of State defines human trafficking in The Trafficking Victims Protection Act of 2000 as sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age; or the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. Human trafficking is a violation of human rights and a global pandemic. Emergency physicians are often the first group of health care professionals to interact with victims of human trafficking with over 88% of victims seeking medical care in a variety of health care settings. Emergency physicians will likely encounter victims of human trafficking at some point in their careers and will be called upon to provide not only medical care for various concerns, but also emotional and psychological support. Victims of human trafficking may present to emergency departments for a myriad of medical complaints including infectious diseases, physical violence, sexual abuse, pelvic pain, hazardous working conditions, unintended pregnancies, abortions, malnutrition, dental disease, anxiety, chronic pain, posttraumatic stress disorder (PTSD), depression, substance use disorders, suicidal ideations, or suicide attempt. Unfortunately, many emergency physicians lack the knowledge and tools needed to recognize these victims. In this article, we will dive into some basic information that all health care providers need to identify and provide treatment to victims of human trafficking.
Risk Factors
It is often difficult to identify those individuals who may be victims of human trafficking. However, we provide certain risk factors that could assist in the identification of human trafficking victims:
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• Poverty • Racial/ethnic minority status • Marginalized individuals (LGBTQ, runaway youth, Native Americans, indigenous people) • Rural location • Lack of education • Disability • Inadequate family support and protection • Migration
Red Flags and Indicators of Human Trafficking
• Someone else is speaks for the patient and refuses to let the patient have privacy • The patient exhibits fear, anxiety, or tension • The patient is reluctant to explain his/her injuries or they share a scripted/inconsistent history • Tattoos or other forms of branding are visible on the patient • The patient reports an unusually high number of sexual partners, STDs, pregnancies, miscarriages, or terminations • Language [or slang] is used that is common in the commercial sex industry (Examples of such terms can be found here: Know the Language of Human Trafficking: A Glossary of Sex Trafficking Terms (amuedge.com))
Screening Tools and Questions
Once you have identified these red flags, the next step is to provide screening questions to your patient: • What are your working or living conditions like? • Have you ever been deprived of food, water, sleep, or medical care? • Can you leave your job or situation if you want? • Can you come and go as you please? • Who is the person who came with you today? Can you tell me about them? • Have you ever been threatened or intimidated? • Has anyone threatened to hurt you or your family if you leave? • Do you have a debt to someone you cannot pay off?
